The incidence of major morbidity in critically ill patients managed with pulmonary artery catheters: a meta-analysis.

INTRODUCTION

The impact of pulmonary artery (PA) catheters on patient outcome has been questioned and their usage has become controversial. Meta-analysis on mortality has shown a trend for improved survival with PA catheter-guided therapy. We now perform a meta-analysis on morbidity from PA catheters in the published literature.

METHODS

We did a search of the medical database (Medline) from 1970 through 1996, using the headings "pulmonary artery catheterization," "Swan-Ganz catheterization" and "right heart catheterization," and restricting the results to "effectiveness" and "usefulness." We also consulted with other experts regarding published randomized controlled trials (RCTs). This yielded 16 RCTs addressing the question of effectiveness of PA catheter-guided treatment. Of these, 12 were found to include data on morbidity. Major morbidity, defined as organ failures as per the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference criteria, from these trials was entered into a formal meta-analysis.

RESULTS

A total of 1,610 patients from the 12 trials were analyzed. Morbidity events were observed in 62.77% of the PA catheter treatment group, and in 74.34% of the control group. A relative risk ratio of 0.78074 was obtained, with a 95% confidence interval of 0.6459-0.94374 and a corresponding p of .0168, a lower morbidity in the PA catheter treatment group. Those with PA catheter-guided treatment had a mean protective effect of 21.9% for risk of morbidity. Other important covariates such as acuity of illness, quality score of trials, year of publication, type of PA catheter-guided treatment used (PA catheter vs. no PA catheter, or PA catheter vs. PA catheter for supranormal hemodynamic values), and surgical or mixed patient population, all increased variability and were not statistically significant predictors for risk ratio of morbidity.

CONCLUSIONS

Meta-analysis of RCTs included in this study shows that there is a statistically significant reduction in morbidity using PA catheter-guided strategies.